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Dermatitis caused by Paederus fuscipes Curtis, 1840 (Coleoptera:

Staphilinidae) in student hostels in Selangor, Malaysia

Article  in  The Southeast Asian journal of tropical medicine and public health · March 2013

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 Paederus Dermatitis Among Malaysian University Students

CASE SERIES

DERMATITIS CAUSED BY PAEDERUS FUSCIPES

CURTIS, 1840 (COLEOPTERA: STAPHILINIDAE) IN
STUDENT HOSTELS IN SELANGOR, MALAYSIA
CC Heo1, B Latif1, WM Hafiz1 and HZ Zhou2

1
Faculty of Medicine, Universiti Teknologi MARA, Sungai Buluh Campus,
Jalan Hospital, Sungai Buluh, Selangor, Malaysia; 2Key Laboratory of
Zoological Systematics and Evolution, Institute of Zoology,
Chinese Academy of Sciences, Chao Yang, Beijing, PR China

Abstract. We report a series of dermatitis cases caused by the staphilinid beetles,

Paederus fuscipes Curtis, among university students staying in the residential col-
lege in Puncak Alam, Selangor, Malaysia from 1 January to 31 December 2010. A
total of 360 cases (6.0%) were recorded in the Student Health Center throughout
the year; the majority of patients stayed at a hostel near an oil palm plantation.
Skin symptoms included erythema, edema, vesicular papules, painful blisters,
burning sensation, pruritus, hyper pigmentation and peeling of skin. The com-
monly involved sites were the face, neck, shoulders and arms. Most students
noticed the symptoms upon awakening in the morning. The patients were treated
with fusidic acid cream and the symptoms resolved within 5 days. These beetles
are nocturnally active and enter the room whenever a light source is available.
The unintentional crushing of these beetles during sleep causes the release of its
hemolymph (paederin) which is the cause of the dermatitis.
Keywords: Paederus fuscipes, dermatitis, student hostel, Malaysia

INTRODUCTION and consists of approximately 621 spe-

Medically important beetles are
mainly from the families Meloidae,
Oedemeridae and Staphilinidae (Nik-
bakhtzadeh and Tirgari, 2008). The rove
beetle, Paederus fuscipes Curtis, 1840, is a
member of the family Staphilinidae, order
Coleoptera (Li and Zhou, 2009). The genus
Paederus is widely distributed worldwide
Correspondence: CC Heo, Faculty of Medicine,
Universiti Teknology MARA, 40450 Shah Alam,
Selangor, Malaysia.
Tel: +6 (03) 5544 2862; Fax: +6 (03) 5544 2831
E-mail: chin@salam.uitm.edu.my
cies, with its only absence in Antarctica
(Frank, 1988). The body sizes of the adult
beetles are 7-10 mm long and 0.5 mm wide
(George and Hart, 1990). They have a
black head; the pronotum and abdominal
segments III to VI are orange, the elytra
is metallic blue and abdominal segments
VII to VIII are black. The appendages are
partly orange and partly black. The bright
colors of Paederus are a warning sign
(aposematism) to potential predators that
they are venomous and inedible (Lott and
Anderson, 2011). Paederus beetles breed in
moist areas, wetlands and salt marshes

Vol 44 No. 2 March 2013 197

 Southeast Asian J Trop Med Public Health
among rotting vegetation; the beetles
appear to be predacious (Triplehorn and
Jonson, 2005). Although these insects
are able to fly, they prefer to run; when
running, they frequently raise the tip of
their abdomen (Triplehorn and Johnson,
2005); this particular behavior is useful
for identification (Vegas et al, 1996). Pae-
derus beetles are beneficial insects in the
agricultural sector because they prey on
crop pests (Frank and Kanamitsu, 1987).
A study conducted in Malaysia found that
Paederus fuscipes is an aggressive leafhop-
per predator in rice fields (Manley, 1977).
Outbreaks of paederus dermatitis
have been reported in various countries,
including Argentina (Dallas, 1939), Aus-
tralia (Todd et al, 1996), Brazil (Diógenes,
1994), China (Li, 1990; Jiang et al, 2008;
Huang et al, 2009), the Congo (Vasudevan
and Joshi, 2010), Ecuador (Campos, 1927),
Egypt (Assaf et al, 2010), Guinea-Conakry
(Vanhecke et al, 2010), India (Verma and
Agarwal, 2006; Padhi et al, 2007; Gnanaraj
et al, 2007), Iran (Zargari et al, 2003; Ab-
basipour and Taghavi, 2005), Iraq (Al-
Dhalimi, 2008), Italy (Gelmetti and Gri-
malt, 1993; Veraldi and Süss, 1994), Japan
(Armstrong and Winfield, 1969), Kenya
(Van Schayk et al, 2005), Malawi (Deneys
and Zumpt, 1963), Namibia (Deneys and
Zumpt, 1963), Nigeria (George and Hart,
1990), Peru (Alva-Davalos et al, 2002), Si-
erra Leone (Qadir et al, 2006), South Korea
(Kim et al, 1989; Kim et al, 1995), Sri Lanka
(Kamaladasa et al, 1997), Sudan (Lewis,
1958), Taiwan (Huang et al, 2010), Tanza-
nia (Fox, 1993; Mbonile, 2011), Thailand
(Papasarathorn et al, 1961; Suwannahi-
tatorn et al, 2007), Turkey (Sendur et al,
1999), Uganda (McCrae and Visser, 1975)
and Venezuela (Rivas et al, 2001). Norton
and Lyons (2002) even proposed the inva-
sion of paederus dermatitis in Egypt by
Paederus alfierii as the plagues that were
198
mentioned in the Exodus.
In Malaysia, paederus dermatitis
was first reported in 1919 (Raju, 2002).
Mokhtar et al (1993) reported an outbreak
among 12 medical students in Universiti
Sains Malaysia at Kubang Kerian Cam-
pus, Kelantan. The second outbreak was
reported in a primary school in Tereng-
ganu involving 36 pupils (Rahman and
Norjaizah, 2008). In September 2002, two
thousand people living in high rise flats
and dormitories in Penang were affected
by dermatitis caused by P. fuscipes.
We report a series of dermatitis cases
caused by the staphilinid beetles, Paederus
fuscipes, among the university’s students
who stay in Puncak Alam, Selangor,
Malaysia from 1 January to 31 December
2010.
CASE SERIES
The cases of dermatitis were first
noted in July 2009 at university hostels on
Puncak Alam campus, Selangor (3º 12’12’’
N 101º 27’5’’E) which is located about 47
km from Kuala Lumpur. There are 12 stu-
dent colleges on the campus with around
6,000 students.
A total of 360 cases were recorded at
the Student Health Center throughout
the year (Fig 1). The majority of patients
stayed in a hostel located near an oil palm
plantation. The student ages ranged 18-20
years. The skin symptoms included ery-
thema, edema, vesicular papules, painful
blisters, burning sensation, pruritus, line
lesions, hyper pigmentation and skin
peeling.
The common sites of involvement
were the face, neck, shoulders and arms
(Fig 2), while the other parts of body,
such as the periorbital region, chest,
abdomen and legs were rarely involved.
Most students noticed the symptoms
Vol 44 No. 2 March 2013
 Paederus Dermatitis Among Malaysian University Students

A B

C D

Fig 2–Sites of involvement (arrow) seen in paederus dermatitis cases. A, face (chin area); B, neck;
C, right shoulder; D, left forearm. Note the typical line lesion in A, B and D.

80 Paederus dermatitis cases in 2010 upon arising in the morning. Some of the
70 students sought medical treatment at the
60 Student Health Center, which is located
on the campus, but many ignored their
Case
50
40 symptoms or self-treated, with antiseptic
30 cream or calamine lotion. Those who saw
20 the medical officer at the Health Center
10 were prescribed fusidic acid cream and
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
the symptoms resolved within five days.
In some cases linear scars and hyper pig-
mentation developed and persisted after
Fig 1–Total cases of paederus dermatitis record-
ed at the Student Health Center at Pun-
treatment.
cak Alam campus, Universiti Teknologi The students found a large quantity of
MARA in 2010. these beetles around their residences. The

Vol 44 No. 2 March 2013 199

 Southeast Asian J Trop Med Public Health
pronotum
elytra
Fig 3–Adult beetle of Paederus fuscipes (Coleop-
tera: Staphilinidae). The length of elytra
is longer and wider than the pronotum.
beetles were found in their rooms, in the
corridors, in the toilets and on the walls.
Most of the students claimed to have no
previous history of skin allergies. They
had been warned by the senior students
regarding the skin lesions caused by an
ant-like insect, which they call semut
kayap, semut semai or charlie. However,
not all students were able to recognize the
Paederus beetles correctly.
We carried out an entomological in-
vestigation to identify the etiologic agent
that caused the dermatitis outbreak. Beetle
specimens were collected from the student
rooms, toilets and the hostel corridors.
The specimens were preserved in 70%
ethanol and then sent to the last author
for identification. The beetles were subse-
quently confirmed to be P. fuscipes (Fig 3).
Paederus fuscipes is identified based
on the features described by Lott and
Anderson (2011).
200
DISCUSSION
Paederus dermatitis may affect peo-
ple of any sex, age, race or socioeconomic
status. The risk depends on the parson’s
activities and the insect habitat, exposed
skin areas are at higher risk (Singh and
Ali, 2007). The incidence of paederus der-
matitis increases during the rainy season
(Mokhtar et al, 1993; Vegas et al, 1996;
Frank and Kanamitsu, 1987). Rahmah
and Norjaiza (2008) noted there was more
rainfall in February 2005 than February
2004; this could be an explanation for
the increase in these beetles. In Tanzania,
paederus dermatitis and conjunctivitis oc-
curs during the rainy season in the north
(Fox, 1993). Recently, Senel and Sahin
(2011) stated global warming may cause
an increase in the incidence of paederus
dermatitis, since higher temperatures
influence the ecological dynamics of the
insect species.
In our study, the peak incidence was
noticed from June to August 2010. This
may be due to the matriculation of new
students at that time. Many new students
became aware of the skin condition for
the first time, having never been exposed
to this kind of skin condition before. The
incidence decreased after September.
Most of the patients did not seek treat-
ment at the Health Center; as they may
have gotten used to the situation, ignored
the symptoms or self-treated. There was
a semester break at the end of the year.
Hence, only few cases were reported. We
assume the actual incidence was higher
but many cases were not reported to the
Student Health Center.
The Paederus beetle does not bite or
sting, but releases toxic hemolymph when
it is accidentally crushed on the skin; this
hemolymph produces an inflammatory
reaction known as paederus dermatitis or
Vol 44 No. 2 March 2013
 Paederus Dermatitis Among Malaysian University Students
dermatitis linearis (Gelmetti and Grimalt,
1993; Singh and Ali, 2007). We believe
the students crushed the beetles during
sleep since the beetles were present in
their room at night, since these beetles are
nocturnally active and attracted to light.
Some students admitted to having contact
with these beetles.
Paederus dermatitis is a self-limiting
skin condition, that includes erythema-
tous and bullous lesions on exposed
areas of the body after contact with the
hemolymph which contains paederin, a
potent vesicant (Frank and Kanamitsu,
1987; Singh and Ali, 2007). Paederin
(C 25 H 45 O 9 N) is more potent than the
venom of a black widow spider (Lactro-
dectus) and it is the most complex non-
proteinaceous insect defensive secretion
(Mullen and Durden, 2009). The synthesis
of paederin relies on the activities of an
endosymbiont bacterium in the female
beetles (Piel, 2002); this bacterium is
passed from the mother to the offspring
in the eggshells, which are eaten by the
emerging larvae (Kellner, 2003). Borroni
et al (1991) found paederin caused a wide
spectrum of histopathology changes, such
as epidermal necrosis and blistering dur-
ing the early phase and acanthosis with
mitotic figures in the later phase. Ocular
involvement, known as “Nairobi eyes”,
is usually secondary to rubbing eyes
with hands contaminated with paederin.
Edema, conjunctivitis and excess lacrima-
tion are common symptoms (Fox, 1993).
In some cases, paederus conjunctivitis
can result in temporary blindness (Frank
and Kanamitsu, 1987). An interesting ac-
count of keratitis among motorcyclists
induced by Paederus beetles was reported
by Huang et al (2010).
A dermatitis outbreak in Terengganu
was initiated by a beetle invasion in a
classroom of 36 schoolchildren, when they
Vol 44 No. 2 March 2013
were attending a night class (Rahmah and
Norjaiza, 2008). Similarly, an outbreak of
paederus dermatitis was reported at a
suburban hospital in Sri Lanka where the
staffs have been working during the night
shift two days prior to the onset of symp-
toms (Kamaladasa et al, 1997). In our case,
the students tended to open the window
at night to promote air ventilation and
then switched on the fluorescent lights
when they were studying. As a result, the
Paederus beetles were attracted into the
room and came into contact with humans.
Mokhtar et al (1993) found the face
was the most common site of involve-
ment, followed by the neck; pruritus was
the most common symptom among 12
medical students. Rahmah and Norjaiza
(2008) found 89% of cases presented with
itchiness as their first symptom, followed
by periorbital edema and erythematous
vesicular plaques in 58% of cases. Sixty-
six point seven percent of cases among
schoolchildren presented with burning
sensation. Mokhtar et al (1993) observed
83% of patients had a complete recovery
while 16% had residual hyperpigmenta-
tion. Wang et al (2004) reported the scar
caused by P. fuscipes could remain as long
as nine months. The patients in our study
had similar experiences. One student
reported the degree of pruritus increased
during sweating.
The adult P. fuscipes are commonly
found in marshes, paddy fields and school
fields (Armstrong and Winfield, 1969;
Kamaladasa et al, 1997). In Terengganu,
paederus dermatitis was reported to be
associated with paddy fields (Rahmah
and Norjaiza, 2008). There were no paddy
fields near the hostels but the majority
of affected patients came from the hostel
adjacent to an oil palm plantation, sug-
gesting the oil palm plantation might be
a natural habitat for P. fuscipes. However,
201
 Southeast Asian J Trop Med Public Health
the first author observed P. fuscipes on
Shah Alam campus, Universiti Teknologi
MARA (3º3’57”N 101º29’58”E), where it
is urbanized and highly populated. We
suspect these beetles are not confined to
agricultural lands, but may also live in
developed areas. A few cases of paederus
dermatitis have also been noticed in the
student hostel on the Shah Alam campus.
As a self-healing skin disorder,
paederus dermatitis needs no specific
treatment. Application of wet dressings
and topical steroids should be sufficient.
Antibiotics can be prescribed to prevent
bacterial infection, if necessary (Gelmetti
and Grimalt, 1993). Vasudevan and Joshi
(2010) found the combination of steroid,
antibiotic application and oral antihis-
tamines was effective in treating 94%
of cases. In our study, only fusidic acid
cream was given to the students to pre-
vent secondary infection. Some students
did not attend the clinic but self-treated
using calamine lotion, but they claimed it
had little effect. The same observation was
made by Fox (1993) where the patients in
East Africa used toothpaste and mud to
treat paederus dermatitis. These methods
were found to be ineffective.
We recommend the installation of
window mesh, fogging of insecticide,
setting up physical traps, improving en-
vironmental sanitation and enhancing the
public awareness to decrease the incidence
of paederus dermatitis. This includes
educating the students to recognize the
Paederus beetle and avoid handling or
crushing the insects. Washing skin exposed
to the beetles with soap and water im-
mediately can greatly diminish the effect
of paederin. Rahmah and Norjaiza (2008)
observed the beetle population is reduced
by closing classroom doors and windows
and fixing the screen to ventilation panes.
Excess vegetation on the school compound
202
should be cleared since the beetles live in
this habitat. Rahmah and Norjaiza (2008)
also suggested thermal fogging at the
school and residual spraying on the walls
of the classroom and ceiling around the
lights since these beetles are susceptible
to insecticides. The teachers in the school
were advised to use aerosol insecticide
spray whenever they detected Paederus
beetles. Some students in our study made
their own physical traps using adhesive
tape to trap or immobilize beetles in their
room. Adhesive can be placed near lights
and trap beetles effectively at night.
Paederus dermatitis may be mis-
diagnosed. A student from Shah Alam
campus was prescribed acyclovir. Other
causes of allergic contact dermatitis (eg,
millipede dermatitis) and liquid burns
may be diagnosed instead (Gelmetti and
Grimalt, 1993).
Awareness of this condition and its
clinical features, especially during the
rainy season, and a careful history tak-
ing (eg, contact with the insect) should
enable the clinician to arrive at the right
diagnosis. There may be variation in pre-
sentation and this problem should be kept
in the differential diagnosis of dermatitis.
This is the third case series report of pae-
derus dermatitis in Malaysia. We hope to
enhance concern among the medical com-
munity about the presence of this beetle
dermatitis in this region.
ACKNOWLEDGEMENTS
We would like to thank Mr Hj Razali
Mohd (Medical Assistant) for his help
during our study on the Puncak Alam
campus, Universiti Teknologi MARA. We
are also grateful to Prof Dato’ Dr Khalid
Yusoff, Dean of the Faculty of Medicine,
for his continuous support and the labora-
tory facilities.
Vol 44 No. 2 March 2013
 Paederus Dermatitis Among Malaysian University Students
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